HomeMy WebLinkAboutApplication For Building PermitOFFICE USE ONLY:
DATE FILED:
PLAN REVIEW FEE:RECEIPT NO.: r
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER:
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
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St. Lucie County Building and Zoning 2300 Virginia Avenue
'�1OR40p • Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT/ d
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
—R#OJECT INFORMATION
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1. LOCATION/SITE ADDRESS: �+�j�% X 7 L.. 0} C ir—% C�
2. S/D NAME: _ SITE PLAN NAME. PaIM4 VU7A C O
3. PROPERTY TAX ID �Ud V
4. LEGAL DESCRIPTION (ajtach extra sheets ifnecespary:
q�(�
5. PLAT 6. PAGE 7. BLOCK 8. LOT
BOOK NO. NO. NO.
9. PARCEL SIZE: ACRES/SQ FT. D"1 LOT DIMENSIONS
10. DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: W 7-fa an aO- A
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT: LEFT:
SIDE SIDE
12.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] RESIDENTIAL [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE:rL
J INTERIOR RENOVATION
[ ] INDUSTRIAL
14. Sq. Ft./CONSTRUCTION: F7 15. Sq. Ft. 1st Floor:
16. VALUE OF CONSTRUCTION: $
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the right to question and7or modify the indicated —(
value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a i J
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02 �I
IV
INFORMATION
NAME: b A-gK cxfj G T-ab ,
ADDRESS: 781 ,Sf N VJ 5 7RO I ,
CITY: kh i A-p" t 1 ��_ STATE: L ZIP
PHONE (DAYTIME): (') email: _� �/CIA N ! � 6o Cps
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW. I / 9 /1
ADDR
CITY:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: L%���3 (7 ST. LUCIE COUNTY CERT #:
BUSINESS NAME: r'
QUALIFIERS NAME:
ADDRESS: t u; S K) -C-,(-�e Ccu'ct
CITY: oa lore- d ay— STATE: ZIP 333 3 �f
PHONE (DAYTIME): _s1 I. 2J,02_ FAX email:
email:
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME): �)
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
NKV0cl
ZIP
ZIP
ZIP
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it will be voided and returned to you by mail.
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CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT, TITLE,
AND INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS
PERMIT YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED
CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT
TO ATTACHMENT.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
- 6�r
OWNER/CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF &—OW A-9-0
The foregoing instrument was acknowledged
before me this day of M,It4 20c6 b
', erson who ally
own o me or who has produced
as identification.
lie,
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF &ot,, &2,0
The foregoing instrument was acknowledged
before me this & day of r l o'er, 20 b
t ivy , who i ersona
own me or who has produced
as identification.
Signature of Notary Signature of Notary
CSIZTJ'7E CD,.u2TJU C'A
Type or Print Name o1ppU7ETlC,51•,r or filop.ITJi$ Type or Print Name of Notary
Commission No. �,� �; c�Seal); r0% - i I;; „S }•� Commission No. �YpL eal)
Boaded Trsu Atic;adc 3oG5 Lic Ce., Jac. go ��.tif E CF O
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOT
THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSON�(PI,'y N
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION. uQOd, co.2OO9
' fuc,
For specific instructions see appropriate permit checklist.
J %
OFFICE USE ONLY BP #:
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT C VG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
EWER
SPRINKLERS
STORMWATER
LOT OF REC
(before 1/90)
LOT OF REC (after
1/90)
LOT SPLIT
REQUIREDI
LOT SPLIT
I APPROVED
ADMINST
VARIANCE
LIBRARY
IMPACT FEE
PARKS
IMPACT FEE
PERMIT
FEE
REPORT
CODE
QD
o
PUBLIC BLD
IMPACT FEE
HABITABLE
AREA
RADON FEE
SCHOOL
IMPACT FEE
GROSS ROAD
IMPACT FEE
DUE
-(RADON)
C IT
Y
N.
TOTAL ROAD
IMPACT FEE
SCHOOL
IMPACT FEE
CREDIT
N
TOTAL
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEE
TOTAL
POLICE/FIRE
MISC FEES
ADDITIONAL
PERMITS
REQUIRED
Y
N
SPECIFY
TOTAL
of ALL
FEES
REVIEWS
ZONING
ZONING
REVIEWED BY
PLANS
EXAMING
MISC.'
VEGETATION
SEA TURTLE
MANGROVE
DATE
COMPLETE
cg
INITIALS